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Matteo Cescon, MD; Gian Luca Grazi, MD; Massimo Del Gaudio, MD; Giorgio Ercolani, MD; Matteo Ravaioli, MD; Bruno Nardo, MD; Antonino Cavallari, MD

Arch Surg. 2003;138:547-552.

Hypothesis  The increasing number of elderly patients undergoing liver resections mandates updating of clinical outcomes on this specific population.

Design  Case series.

Setting  A tertiary care teaching hospital.

Patients  Twenty-three patients older than 70 years who underwent right hepatectomies (including 7 extended right hepatectomies) between January 1, 1995, and October 31, 2001 (group 1) and 99 patients younger than 70 years who underwent 64 right hepatectomies and 35 extended right hepatectomies during the same period (group 2) were included for a total sample population of 122.

Main Outcome Measures  Preoperative clinicopathological features, intraoperative factors, in-hospital mortality, postoperative complications, intensive care unit requirement, hospital stay, and course of main biochemical liver function test results of groups 1 and 2 were analyzed and compared.

Results  The 2 groups were similar for indications for surgery and the presence of underlying liver disease. Group 1 had a higher incidence of associated pulmonary diseases (21.7% vs 5%, P = .02) and patients with an American Society of Anesthesiologists score of III (ie, a patient with severe systemic disease limiting activity, but not incapacitating) (56.5% vs 26.3% of cases, P = .01). There were no differences in intraoperative requirement of packed red blood cells and in operation time. There were no in-hospital deaths in group 1; there were 2 deaths (2%) in group 2. Nine patients (39.1%) in group 1 and 32 patients (32.3%) in group 2 experienced postoperative complications (P = .53), of whom, respectively, 5 (21.7%) and 17 (17.2%) developed transient liver dysfunction (P = .56), and 4 (17.4%) and 5 (5.1%) required a supplementary intesive care unit stay (P = .06). The postoperative stay (mean [SD], 16 [14] days vs 13 [9] days, P = .88) and peak values of the aminotransferase level, total serum bilirubin level, and prothrombin time were similar in the 2 groups. The timing of the peak value of the total serum bilirubin level (mean [SD], 4.1 [4.8] days vs 2.5 [2.5] days, P = .28) and its period of normalization (mean [SD], 9.4 [10.8] days vs 6.7 [5.1] days, P = .67) were also similar for both groups. For patients with malignancies, the 3-year survival rate was 64.2% in group 1 and 53.9% in group 2 (P = .53).

Conclusion  Being older than 70 years should not be a contraindication for major hepatectomies, provided that liver cirrhosis and severe associated medical conditions are ruled out during the preoperative evaluation.

From the Department of Surgery and Transplantation, University of Bologna, Bologna, Italy.

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